Re: Timescale in which newbies should get control

Hi Chris:

"The first is blood pressure control. It is clear that blood pressure control slows the progression of diabetic retinopathy.2 There are now provocative data to suggest that angiotensin-converting enzyme (ACE) inhibitors may independently protect against the development or slow the progression of retinopathy,3,4 perhaps through reductions in retinal vascular endothelial growth factor levels.5

I'll ask about getting back on an ACE. Lisinopril did not agree with
me, but others might.

I often wonder, though, if the benefits of ACe are truly independent
from lowered BP?

I believe that there is some association with insulin resistance/insulin sensitivity. ACE inhibitors may lower IGF-1. IGF-1 may also be associated with insulin resistance. So much of this endocrinology stuff is relative. Consider the small volume of exogeneous insulin that it takes to alter the blood glucose balance. The volume of IGF-1 is even smaller. Relatively speaking a ship without a rudder might be an analogy to a insulin dependent diabetic, but the rudder doesn't have to be very large to control the ship. Weird stuff.

It also needs to be appreciated that rapid improvement of glycemic control may cause a worsening of preexisting retinopathy in both type 1 and type 2 diabetes.6,7 Patients at highest risk for this are those with longstanding poor control with some degree of preexisting retinopathy.8 Absence of any retinopathy at the initiation of improved control does not result in any acute problems.

That wasn't true in my case: A couple of months pre Dx, I had a
retinal exam, and was fine, no retinopathy.

Patients at high risk of early worsening should have more frequent ophthalmologic evaluations. Although not yet formally studied, a common recommendation is a slower improvement in glycemic control for these patients." Solurce: "Seeing" Between the Lines -

This seems to be the big issue: is slower better, and if so how slow?
I've seen cites both ways on this one, and it's the issue I most need
to resolve.

My note: You are not likely to know your baseline serum IGF-1 levels.

I don't; it's never been on my blood tests.

I know that I have never been tested. While the patients were type 1, the rapid big shift in glycemia with the associated changes in IGF-1 is the issue. I don't see any reason for you to wait to get your IGF-1 level measured. IGF-1, ng/ml, normal range 71-290 (>55 yr). I know you are much younger than this, but this is a starting point for a reference range.

I'm still waiting to find out if my lab can test IGF-1. I should know
tomorrow. However, I am going to have a full blood test done if I do
this (might as well) and include thyroid, lipids, and A1c.

I hope that the various posts that you have received will assist you in asking the appropriate questions on your upcoming visits with different doctors. Much of this has been new to me as well as over my head, but I tried to give it a shot. I don't want to get into bull jiving for the sake of bull jiving. I haven't admitted this to many people who are my acquaintance, but in the last 5 years my favorite phrase has become "bull shit." ;)

Frank Roy
Jefferson, Md.

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